| NPI | 1699343855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2025011759) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 81475) |
| 207Q00000X Family Medicine (Licence: WI 81475) | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2025-09-17 |